During a prolonged in-hospital resuscitation, the team leader orders a change of the chest compressor every 2 minutes even though the current compressor states he feels fresh and can continue. The physiological rationale for this rule is:

• A Coronary perfusion pressure plateaus after 2 minutes unless the compressor is changed
• B Prolonged compression by one rescuer increases the risk of rib fractures beyond 2 minutes
• C Rhythm analysis accuracy falls if the same rescuer performs compressions and operates the defibrillator
• D Compression depth and rate decline measurably before the rescuer subjectively perceives fatigue ✓

Explanation

Studies of CPR quality show that compression depth and rate deteriorate significantly within 1 to 2 minutes of continuous compressions, well before the rescuer reports subjective fatigue. Scheduled rotation every 2 minutes, timed with the rhythm check, preserves compression quality. Rib fracture risk depends on depth and duration overall, not on a single rescuer. Coronary perfusion pressure depends on compression quality and adrenaline, not on who compresses.

Reference: AHA Guidelines for CPR and Emergency Cardiovascular Care, 2020 ed.

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Written and medically reviewed by the StethoPrep medical team.